鞍结节脑膜瘤的显微外科治疗(附30例报告)

Microsurgery for tuberculum sellae meningiomas(a report of 30 cases)

目的探讨鞍结节脑膜瘤显微手术治疗效果。方法对30例行显微手术治疗的鞍结节脑膜瘤患者的临床资料及手术效果进行分析总结。结果肿瘤全切(Simpon分级Ⅰ、Ⅱ级)24例,次全切(Simpon分级Ⅳ级)4例,大部分切除2例。术中去骨瓣减压2例。手术死亡1例。术前有视力下降的26例患者中,术后早期视力改善20例,无变化4例,恶化2例。术后随访3～38个月,2例术中去骨瓣减压的患者分别于术后6个月及8个月时行颅骨缺损修补术;24例肿瘤全切病例中,3例患者有肿瘤复发,2例行二次手术,1例选择放射治疗。失访3例。结论鞍结节脑膜瘤位置深在,与周围血管神经等重要结构关系密切,但积极的显微外科手术治疗效果良好。

Objective To explore the curative effect of microsurgery on tuberculum sellae meningiomas.Method The clinical data of 30 patients with tuberculum sellae meningiomas undergoing microsurgery from January,2000 to January,2008 were analyzed retrospectively.Results Of the 30 patients with tuberculum sellae meningiomas,24 received total resection of the tumors and 4 subtotal resection and 2 part resection.Decompression was performed in 2 cases because of the brain edema.One patient died postoperatively.Of 26 patients with visual disturbance before the operation,20 were significantly improved in the visual power,4 had unchanged in the visual power and 2 suffered from visual deterioration after the operation.Twenty-six patients were followed up from 3 to 38 months.Two patients undergoing the decompression received cranioplasty respectively 6 and 8 months after the operation.The tumors recurred during following up in 3 patients,of whom,2 underwent the second operation and 1 received radiotherapy.Conclusion Although tuberculum sellae meningioma is located in the skull base,and close to the important vessels and nerves,the satisfactory clinical outcome of microsurgery for tuberculum sellae meningioma may be achieved.